📄 Final care plan (review & edit above as needed)

Suggested differentials

Canadian routine childhood immunization schedule (birth–17 years)

• Birth: an RSV monoclonal antibody (nirsevimab or clesrovimab) is recommended for infants entering their first RSV season if the birthing parent did not receive the RSVpreF vaccine during pregnancy; hepatitis B may also be started at birth depending on the product/schedule used
• 2, 4, and 6 months: the primary series of a combination vaccine covering diphtheria, tetanus, acellular pertussis, polio, and Hib (DTaP-IPV-Hib), sometimes combined with hepatitis B into a single product (DTaP-HB-IPV-Hib); pneumococcal conjugate vaccine (Pneu-C-15 or Pneu-C-20) at 2 and 4 months; rotavirus vaccine (2 or 3 doses depending on product, all completed before 8 months of age); meningococcal C conjugate per the provincial/territorial schedule
• 12–15 months: a booster dose of meningococcal C conjugate, generally at 12 months; first dose of MMR and varicella (either as two separate vaccines or combined as MMRV) at 12–15 months; a pneumococcal booster dose if using a 3-dose primary schedule
• 18 months: a 4th (booster) dose of the DTaP-IPV-Hib combination vaccine; second dose of MMR and varicella (or MMRV), which can be given anytime from 18 months but no later than around school entry
• 4–6 years: a booster dose of DTaP-IPV or Tdap-IPV
• 9 years: hepatitis B (2–3 doses if not previously immunized) and HPV (1 dose of the nonavalent vaccine is now standard; a 2-dose schedule may be considered individually)
• 12 years: Tdap booster; a meningococcal conjugate booster (Men-C-C or Men-C-ACYW depending on local epidemiology), even if a dose was already given earlier in childhood
• Influenza is recommended annually starting at 6 months of age — children under 9 receiving it for the first time need 2 doses at least 4 weeks apart; after that, or once age 9 or older, it becomes a single annual dose

Source: Public Health Agency of Canada / NACI — view current official schedule →

Canadian catch-up immunization principles (not previously immunized)

• Core principle: an interrupted immunization series does NOT need to be restarted from the beginning, regardless of how long the gap has been — simply resume and complete the appropriate schedule for the person's current age
• For children under 7 not previously immunized as infants, a structured multi-visit catch-up schedule is used: first visit, then follow-up visits at 4 weeks, 8 weeks, and 6 months after the first visit, covering the combination diphtheria/tetanus/pertussis/polio/Hib vaccine, pneumococcal conjugate, meningococcal C, MMR, varicella, hepatitis B, and influenza as age-appropriate
• For children 7–17 not previously immunized, a similar accelerated catch-up schedule is used, but with Tdap-containing (not DTaP-containing) pertussis vaccine given the older age, along with age-appropriate meningococcal conjugate, MMR, varicella, hepatitis B, HPV, and influenza
• For adults never previously immunized, a primary series of Td (or Tdap-containing, if no prior pertussis-containing dose in adulthood) is given at first visit, 4 weeks later, and 6–12 months after the second dose — with one pertussis-containing dose given during adulthood regardless of when in the series
• When in doubt about a specific product, dosing interval, or age cutoff for catch-up scheduling, consult the official schedule or the relevant vaccine-specific chapter rather than estimating — catch-up scheduling has enough product-specific variation that guessing carries real risk of under- or over-immunizing

Source: Public Health Agency of Canada / NACI — view current official schedule →

Canadian adult immunization schedule (18+ years)

• Tetanus/diphtheria/pertussis: adults previously immunized need a Td booster every 10 years, plus one Tdap (pertussis-containing) dose at some point in adulthood regardless of timing since the last Td — and one Tdap dose during every pregnancy, ideally between 27–32 weeks gestation, to protect the newborn
• MMR: adults born in or after 1970 generally need only 1 dose unless they're a traveler, healthcare worker, post-secondary student, or military personnel (who need 2 doses); adults born before 1970 are generally presumed immune to measles/mumps from natural exposure, though rubella-susceptible adults of any age still need 1 dose
• Varicella/zoster: adults 18–49 without evidence of varicella immunity need 2 doses of varicella vaccine; adults 50 and older are generally presumed immune to varicella itself, and instead become eligible for the recombinant zoster (shingles) vaccine — 2 doses, 2–6 months apart, starting at age 50
• Pneumococcal: 1 dose of Pneu-C-20 is recommended for all adults starting at age 65, regardless of prior pneumococcal vaccination history (with appropriate spacing from any prior dose)
• HPV: catch-up is available well into adulthood — ages 18–20 generally get 1 dose, ages 21–26 get 2 doses, and ages 27+ may consider a 2-dose schedule through shared decision-making with their provider
• Influenza: 1 dose recommended annually for all adults without contraindications, with particular emphasis on pregnancy, age 65+, and those in close contact with high-risk individuals
• RSV: a single dose is recommended for all adults 75 and older, for adults 65–74 with specific risk factors for severe RSV disease, and for certain younger at-risk adults (residents of long-term care, transplant recipients, those on chronic oxygen or dialysis)
• At-risk adults (immunocompromised, chronic disease, occupational or travel exposure, congregate living settings) may need additional or earlier vaccination — Hib, higher-dose or accelerated hepatitis B, meningococcal ACYW or B, hepatitis A, rabies pre-exposure series, or mpox vaccine — largely driven by individual risk factors rather than age alone

Source: Public Health Agency of Canada / NACI — view current official schedule →